HomeMy WebLinkAboutFOX HILL BLK 2 LT 1Fox Hill Block 2 Lot 1 #051-073-07 \ Municipality of Anchorage .,, Development Services Department Building Safety Division : € Onsite Water 8 Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 Onsite Wastewater Disposal System and/or Well Inspection Report Permit Number: SW070300 PID Number. 051-073-07 Name: SALLY GOBLE Wastewater System: ❑ New ■ Upgrade Address: PO BOX 671214 a CHUGIAK, AK 99567 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 242-1564 3 0Deep Trench ■Shallow Trench 0Bad ONound 0Other LEGAL DESCRIPTION Sall RaUN: 0.8 Total Depth hem crlgi hada: 8 MAX olD/Sg. n n Block: Lot: Subdivision: apth w Pb. bottan, tram ono" grad.: Gravel depth beneath pip.: 2 1 FOX HILL SEE DWG. n 4.02 n Township: Range: Section: — — — N added obab onglnal grod•: GravN I."stls 57 SEE DWG. rt. n Gnwel widay. NaniMr of Sne.: DWa s !teem enee: WELL: ❑New [I Upgrade 5 n 1 — n Clowmfi or, private. A.S.0 : Total Dw Cawed T.:(,..00R) Total ob• tion mea:PiD. mot~ D 3034/ F-810 n. n 570 SO. n auw W. Dnued: stork water Lay.t Wdlan.. GEG, Ltd. We "w1wl: 11/7-12/2007 n 1'wld: pump set Ae: Co ming Iblght Above Grwwwl: TANK GPN n n SEPARATION DISTANCES ■septic 0Holding 0S.T.E.P. 0Other* To Septic Absorption I Lift Holding bk/Prtwta 11OM11OC1vrw,. ANCHORAGE TANK Cop«�b 1000 From Tank Field Station Tank sewer un.e well too'+ 100'+ — — 25'+ t/ot..l.t STEEL Nwnb.r of aompar -2 Surface water 100'+ too'+ — — — LIFT STATION Lot Una 5'+ 10'+ — — — Su. In gaily : tdonulactvw: ow beet a: .L lYgh water abrin eL Foundation 5'+ 10'+ — — — =at, ptwnp Nob D.abka kwp.atkwa pwfa br: Curtain Drain NONE KNOWN BENCH MARK Remcrks:OLD SEPTIC TANK WAS PUMPED CRUSHED teeatian and a.arlpwn: AND COMPLETELY ABANDONED. BOTTOM OF SIDING ® SOUTH END OF THE HOUSE Aew,med ENwtkn: 135.53 n ENCANEER's SEAL Inspections performed by: GEG, Ltd. Dates: 1st 11/7/2007 0 2nd 11/8/2007 F OF 3rd 11/12/2007 .S�OpO Development Services Department Approval p'?; y°.QQ . Conditional approval: Date: . ' ' r A... ass QQ� ` CE— Reviewed and approved by: Date: oalProfessta�oa� �D�pppO (Rev. 4/06) PERMIT NUMBER: SW070300 STI 56.87 79.39 ST2 60.78 85.25 D8L1 62.80 87.53 DBL2 64.28 89.44 C01 117.67 133.04 MTI 116.44 129.47 CO2 110.94 107.07 MT2 112.36 109.18 AS -BUILT DRAWING I I \\ 1 1 I 1 1 1 1 � I � PARCEL ID NUMBER: 051-073-07 i IIXISTING TRENCH MFZr / � B NEW DRAINFIELD— / y 41. INSTALLED BULL RUN VALVE �1 S LIE: CP° Y- 40' � � I V 1000 GALLON SEPTIC TANK FOX HILL S/D. LOT2. BLOCK 2 GARNGSS ENGINEERING GROUP, Ltd. -- •- - CONSULTANTS 6 GENERAL CONTRACTORS— =1 ONTRACTORSr-mi L n NWA w loi . w 3otu t M r.. portvs ". PREPARED FOR: PHONE NUMBER: PACE NUMBER: SALLY GOBLE 242-1564 2 OF 3 LEGAL DESCRIPTION: FOX HILL SUBDIVISION. LOT 1. BLOCK 2 TYPE OF WORK: AS—BUILT BY: V u •mac—/yJJ K.D.M. O��ne�-'' (.it13/q'Gc 11/12/2007 TOP OF TANK - AT INLET = 104.38 INVERT OF BUNG - AT INLET = 103.93 TH#1 ORIGINAL GRADE = 90.65 FINAL GRADE = 108.34+ ST1 ST2 TOP OF TANK I -R-, /AT OUTLET = 104.40 NEW 1000 GALLON SEPTIC TANK T 1 -INVERT OF BUNG AT OUTLET = 103.69 FINAL GRADE =92.59 .TER FABRIC INVERT OF PIPE = 86.67 I 5� '*'�,— BOTTOM OF TRENCH = 82.65 GARNLSS ENGINEERING GROUP, Ltd. p°¢'?:' 4 .7` - -- .. CONSULTANTS& GENERAL CONTRACTORS // ......••••• e .. Y""" Ml G new A sort 10t • .wssw 0044M r r • r (W?)l rein • rM (br)us-• • .mne w..w�M�Mae. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •••••• ••••••••••• SALLY GOBLE 242-1564 3 OF 3 OO p '•.J If r y rnessi LEGAL DESCRIPTION: DRAWN BY: OO°yv CE 3 FOX HILL SUBDIVISION, LOT 1, BLOCK 2 K.D.M. 04'ere it}�43 ��Ad TYPE OF WORK: DATE: 4�Q�Y'rof essiov'o`o PROFILE ASBUILT 11/12/2007 D�O000��� 6y_f SEWARD & ASSOMKILZI t cony ASBUILT SCALE, +OF Ate ~ �� � �-I I HEP.EBY CERTIFY THAT SURVEYED THE � �F A.. AT I HAVE / � ••` DATE' r�P; FOLLOWING DESCRIBED PROPEKTY� MFRBS EXIST HMENTS EXCEPT AS AND THAT NO F' IS H••" INDICATED. IT IS THE RESPONSIBILITY OF OF GRID OWNER TO DETERMINE THS EX , Duane Merle y,werA EASEMENTS, COVENANTS, OR RESTRIC710NS WHICH DO NOT APPEAR ON THE RECORDED SUHW-D FB* UNDER NO CIRCUMSTANCES SHOULD VISION PLAT- FOR CONSTRUCTION ANY DATA HEREON BE USED D12A0 f OF FENCE LINES, OR FOR ESTABLISHING, BOUND- : — ARY LINES. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water B Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 31, 2007 Expiration Date: Oct 30, 2008 Permit Number: SWO70300 Parcel ID: 051-073-07 Legal Description: FOX HILL BLK 2 LT 1 Design Engineer: 0855 GARNESS ENGINEERING GROUF Site Address: 021936 WOODCLIFF DR Owner Name: SALLY GOBLE Lot Size: 80211 SO. FT. Owner Address: PO BOX 671214 Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , AK 99567 - This permit is for the construction of. Q Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Issued By Date:///) 6 Date: 31 L7 \ Municipality of Anchorage • '� Development Services Department Building Safety Division fih7 ice' On -Site Water a Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05I— D 3- U4 Property owner(s) SALLY GOBLE Day phone 688-5104 Mailing address PO BOX 671214 e CHUGIAK. AK Site address '�-Ig31r J_Omfy_Lj 'w Zip Code 99567 Legal description (Sub'd, Block & Lot ) FOX HILL, LOT 1. BLOCK 2 Legal description (Township, Section & Range) _N/A Lot Size X 1, �'_I Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR ( ®all that apply): Absorption Field ❑ Septic Tank 19 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION IS AN: Initial ❑ Upgrade 19 Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit/Rush Fees: 116 0 - O (7 Date of Payment:1y�I o 7 Receipt Number: of 5 -% _), _5 (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORSa- October 22, 2007 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic Upgrade for Fox hill Subdivision; Lot 1, Block 2, To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgraded. We are proposing to install a 1000 gallon septic tank and a 5 -wide trench type drainfield. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINF1ELD DESIGN: The existing drainfield will be left in place and connected to the system with a diverter. If the existing trench is able to recover through sitting idle, it can be alternated yearly with the new trench to give both absorption fields recovery time. See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography below the drainfield is a 5-10 percent slope running approximately east to west. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincerely, Pte - Donna C. Mears, P.E., M.U.P. NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic systent. (Contact G.E. G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507-1259 Ph: (907) 337-6179 • Fax: (907) 338-3246' Website: www.gamcssenginecring.com LOT 5. BLOCK 1; DEER PARK S/D i LOT DEER LOT 2. BLOCK 2; FOX HILL S/D LOT 3. BLOCK 2; FOX HILL S/D LOT 4. BLOCK 2; FOX HILL S/D 0 L \ LOT 1, BLK 3, \ DEER PARK S/D \ O � � INFERS 1993 T ST HOLE �\ 5-10x 44 -1 © 1 TOE OF HILL _ I TOP OF C�12X I GARNTESS ENGINEERING GROUP, Ltd. p* ^^--•--= CONSULTANTS 6 GENERAL CONTRACTORS ... ee. 0 >ot c 11gdt euo, trurt tot • wcw�t,cc wt tnror . wto,[ -etn . rur PREPARED FOR: PHONE NUMBER: PACE NUMBER: 0 SALLY GOBLE 688-5104 1 OF 2 �, LEGAL DESCRIPTION: DRAWN BY: QO°a FOX HILL, BLOCK 2, LOT 1 K.D.M. D (TYPE OF WORK: DATE PROPOSED UPGRADE SEPTIC SYSTEM DESIGN 1 (Rev. 01ft) r- xy .........:,�S�DO 49LH ' •C '-.DONNA C. ►AE RS• CE -11135 :,r 0 .�Op�Professbn�� oo/ NUMBER OF BEDR00MS:3 LLT(LR THAT PERTAINS TO TO OBTAIN A COPY OF GALLONS PER DAY (GPD): 450 CONTACT OEC. BY PROCEEI PERCOLATION RATE/S: 10 MIN./INCH WITH THIS INSTALLATION, T PROPOSED APPUCATION RATE: 0.8 I WELL DRILLER, CONTRA MINIMUM GRAINFIELD SO.FT.: 563 PROPERTY OWNER AGREE HAVE READ THESE SPECIFI Mn At rl rl n nrcln„_ AGREE TO ACCEPT THE MAXIMUM DEPTH:B FEET WIDTH:5 FEET LENGT:57 FEET M.OAHAPPROVED SAND FILTER: N/A I \� EFFECTNE:4 FEET \ REDUCTION FACTOR: 0.50 ACTUAL S0.FT.: 570 I / CONSTRUCTION / ENGINEERS 1993 TEST HOLE EXISTING TRENCH .__—__ MT1C0 >25% TH/1� / I IN [al LLEEA ODUTTS PROPOSED DRAINnELD� / V INiALL ZABEL FLOW DIVERTOR OLD SEPTIC TANK TO BE PUMPED, CRUSHED, AND COMPLETELY ABANDONED >23S TOE OF THE HILL N 5 E: CP� I" - 40' I MV4 / —1 \\ PROPOSED 1000 GALLON SEPTIC TANK FOX HILL S/D, LOT2, BLOCK 2 GARNESS CONSULTANTS ENGINEERING ONTRA�TORS GROUP� , Ltd, 3A1 L TAW AdU, lUIC 101 • A40MAM M1 NJO) • AGK (o0».=) jft • IAM (0017000�NN • .RV . wv.ysn,wywhyya, PREPARED FOR: PHONE NUMBER: PAGE NUMBER: SALLY GOBLE 688-5164 2 OF 2 LEGAL DESCRIPTION: DRAWN BY: FOX HILL, LOT 1, BLOCK 2 1 K.D.M. (TYPE OF WORK: PROPOSED SYSTEM 10/18/2007 IJ odPKX....:....... •.11 mq 0 DONNA C. MEARS.: CE -11135 . �I1:�._ ' • 10...... GARN SS o NG SNEERING GROUP, Ltd 7 I}llllll POCKECTS OAND VEL 8 9 10 11 12 13 14• 15- 16- 17- 18- 19- DEPTH 5•16•17- 18- 19- DEPTH TO GROUNDWATER SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: FOX HILL, LOT 1, BLOCK 2 PERFORMED FOR: SALLY GOBLE DAl DEPTH 2 3:30 =Z== (reef) �yya ORGANIC TEST HOLE 1 1 y��7 3:30 — _ _ SOILCLASSIFICATIONS 2 »» LOAM 3• --- 5 'b ` 6 s GW -- ORG ---- 3 6• ,;�+i GP ML 6 4:30 GMICL 4 3• GC OL °• °°• o SWMH 5 •� `'• SP CH SM OH 6 SC 7 I}llllll POCKECTS OAND VEL 8 9 10 11 12 13 14• 15- 16- 17- 18- 19- DEPTH 5•16•17- 18- 19- DEPTH TO GROUNDWATER DATE 10/5/2007 DRY 10/9/2007 DRY 10/12/2007 DRY 6- _ �o �F'. �r••A�.gS\� ... . ......:... P •. DONNA C. M ARS.: CE 11139, e� °�, e'• /Q. 07.-"oa 0 t0 lsio�°oma/ DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 10/9/2007 1 3:00 — 6- _ 2 3:30 30 3• 3- 3 3:30 — 6• _ 4 4:00 30 3• 3- 5 4:00 — 6• _ 6 4:30 30 3• 3• PERCOLATION RATE 10 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4 FT. AND 4.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: KYLE MAUS COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Municipality of Anchorage Page I of 2- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONME=NTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: — 53'"00 PID Number: _._L� Name: M Wastewater System: &-New ❑ Upgrade Address: - - _ Pa fax 6 045%- Cttwcs, K ABSORPTION FIELD Phone: 68 8 1 Z3 (� No. o6Bedrooms: ed ❑ Deep Trench 0 Shallow Trench ❑ Bed ❑ Mound 11 Oth@ r ® ® w19�' 17rJCH /'+A LEGAL DESCRIPTION-Soil � Rating: I 'Z Total Depth from original grade: I J t _ GPU/Sq. Ft. Lot: Block:�^ Su division: I Z 4VL-L Depth to pipe bottom from original grade: Gravel depth beneath pipe Tom-' K a Ft. Fl. _ Township:ange: RSection:) � _ Fill added above or ginal grade: Ft. Gravel length: r Ft. WELL: 'New ❑Upgrade Gravel defglh: L/i> 1 Numberoflines: I Distan!ebetween lines � � Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: 6 Total absorption area: �G—I�r ��-tvt j Pipe material: PC$-reA 'P 303'}/ ViiiyA--re Ft. Ft. 39.4-- SQ. FL PwG F$)a Driller: Date Drilled: Static Water Level: SuLL1V);t� Ft. Installer �T Date installed: MM M �e»,�yu -- 4-7-t 1993 Yield:Pump Set at: Casing Heigh Above Ground: � TANK GPM FL Ft. _ SEPARATION DISTANCES kSeptic El Holdingo S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer 4^� 6\(Dy Capacity in gallons: From Tank Field Station Tank Sewer Lines App Q_J� Well ICS$ n 0' N Material: S1ea� Number of Compartments: Z pr Surface Water +im a Jam' d IUb' LIVET STATION Lot 4Gr 31' 43, Size in gallons: Manufacturer Line Foundation 1CJZ1 c�0 �' "Pump on" level at: level aC High water alarm at: Curtainfir ) J �t 5o t J Pump Make e Electrical Inspections performed by: Drain Remarks: R BENCH MARK _ Location and Description: Assumed Elevation: �.�� ENC, 44 REWL �A f Of At e A L�o°lf�fr.y��N®w Inspections performed by: -ors v 3, _. Dates: lst_$'�Ig3 _ �� 5,NJif 2nd- h1o41�./w�..•P rw�IgM■f�SO4 ®10. I .�► IYN. r7dAl 5 1i93 p I/'Juno A 1%6 ag Department of Health and Hum Aervices appr®"-96"2 /� � AW k%S Reviewed and approved by: _ - Date: _ 72-013 (1/91) MOA 25 / Permlt No. 95-0035 Page — Z' of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: _ L ) 8Z �=O_�< 41LL S vg f]fiTt'.Z 6 ci b}QIG•1N�L } fLIM Sy L��I111—___ <+KAp II TZ 49= M 1 RAP1 fill PLV VX L lAifiiL�Yl Sewat ezcti �'RCNtI�I �3oT�tw. 4c' 92 5 411 PVC. CiaYVomoR vb �1'9xS/wx4G'L M.r, w 1 «L''MrNCO 9a'�_ WALL 411 PVC. � G 5 p , vb 1000 Z C-al-r.L 3SCDI�om 9u'PV4 hv�vss OWDCYL (OiVST. (c -V 10 H t"V 1) MVA Zb cLLN 60.0 6 0 J �6d530 9 9 ° j PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930039 DATE ISSUED: 3/30/93 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC. EXPIRATION DATE: 3/30/94 OWNER NAME:MYERS MICHELLE E OWNER ADDRESS:P. 0. BOX 670459 / ��/C CHUGIAK ALASKA 99567 PARCEL ID:05107307 LEGAL DESCRIPTION: FOX HILL BLK 2 LT 1 LOT SIZE: 80211 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. MAXIMUM DEPTH TO BOTTOM OF INSTALLATION 2. MODIFIED DESIGN USES SINGLE PIPE RUN IN WITH CLEAN OUT AT END. RECEIVED BY: IS 11.5'. 5' WIDE TRENCH DATE: ISSUED BY: i ��� _ DATE:- 2,o/23 SITE PLAN DETAILS ^ PROPOSED WATER AND WASTEWATER ABSORPTION SYSTEM LOT 1 BLOCK 2 FOX HIL]' SUBDIVISION PREPARED FOR: MR. PAUL MEYERS PO BOX 670485 CHUGIAK, AK, 99567 SCALE: 1" = 100' DRAWN BY CAL CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 3--18-93 DRAWING N 93-S1-03-1 I / ! I I / \ � � � No SCPTL �N PR UfroS L-lJl \ da \ WGLL KhDiV$ 100 OF PRO Pdi Llv 1 , PRqll� Tbsr HOLFO` FJZ000Sel) . JGtL F�! FRon F)Rb l7\T> 3-3DR0Lb 41 LpT %�xr.R 1 ZIl S f�_- LEss 5ersrc 5 d t vvoTPz�n�TSa >ZS°la 000 ( ��^ro EVr_waeD / J � 1 !q RCIA AVA1 L1 Le i \ r��Z 5 LF 5 ,3 Z a9- AISSORP' C,o zoN bo R-6 SITE PLAN DETAILS ^ PROPOSED WATER AND WASTEWATER ABSORPTION SYSTEM LOT 1 BLOCK 2 FOX HIL]' SUBDIVISION PREPARED FOR: MR. PAUL MEYERS PO BOX 670485 CHUGIAK, AK, 99567 SCALE: 1" = 100' DRAWN BY CAL CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 3--18-93 DRAWING N 93-S1-03-1 SCOPE OF PROJECT: New .proposed absorption field is designed for a three (3) bedroom system. Lot is to be served by private well to be developed on site. ABSORPTION AREA CALCULATIONS: Minimum Required: 3 Bedrooms x 150gpd/bedroom = 450 gpd capacity Soils rating, proposed addition, 1.2 gpd/sf Minimum sizing: 450 gpd = 1.2 gpd/sf = 375 sf absorption area Due to depth of useable soil, Use wide trench design: 375 sf = 5' W = 125 sf x Correction factor [(W+2):(W+1+2D)] 125 sf x [(5+2) = (5+1+(2)(3))] �= 44' minimum trench length, 51wide x 3' deep IMPACT ON ADJACENT LOPS: There are no private wells within 100' of this proposed absorption system. The proposed absorption system has no adverse impact upon any adjacent lots as shown on attached site diagram. ✓�,�.�, SITE PLAN DETAILS ABSORPTION SYSTEM DESIGN DETAILS --WIDE TRENCH PROPOSED WATER AND WASTEWATER ABSORPTION SYSTEM v �T -t� PREPARED FOR: MR. PAUL MEYER5 SEW E2 dock T y1A CHUGTAK, AK, 99567 • ti ,. erg s >� rk CONSTRUCTING ENGINEERS 346-2000 EF 4"Fl?wX HoVSG 6 .5 ANCHORAGE, AK, 99516 3--18-93 DRAWING N 93-S2-03--1 HouSE z 4" R¢RFoeAticD We Z lL' " j FNDnI TNG • SePAfzPt"bw Z! f o — ---- � ' Ir ���•-� Q x{r S6�lo VC,) PARIF LL 'TZ7 $LOpe �I' MSN COVh2 6v G'�- PIP[ - OR\Gir�A\. G2PDi 'k i 00 1 I uG Z" µp 11,jiv i1T)DO Ov¢KTA"- TYPF'K C"6Z FIE;,t> M _-.r 5E UM ROLk ..�! °Sol -XD pvC Ta G1t; o tj�L Genoe o'-\ ° t N16Nt�`�Yo ALL CO'( WicomPe% 'Nro SrrcL�M>r„� Guam � DPN)rJ �.w PY r2on pkL9. SCOPE OF PROJECT: New .proposed absorption field is designed for a three (3) bedroom system. Lot is to be served by private well to be developed on site. ABSORPTION AREA CALCULATIONS: Minimum Required: 3 Bedrooms x 150gpd/bedroom = 450 gpd capacity Soils rating, proposed addition, 1.2 gpd/sf Minimum sizing: 450 gpd = 1.2 gpd/sf = 375 sf absorption area Due to depth of useable soil, Use wide trench design: 375 sf = 5' W = 125 sf x Correction factor [(W+2):(W+1+2D)] 125 sf x [(5+2) = (5+1+(2)(3))] �= 44' minimum trench length, 51wide x 3' deep IMPACT ON ADJACENT LOPS: There are no private wells within 100' of this proposed absorption system. The proposed absorption system has no adverse impact upon any adjacent lots as shown on attached site diagram. ✓�,�.�, SITE PLAN DETAILS PROPOSED WATER AND WASTEWATER ABSORPTION SYSTEM LOT 1 BLOCK 2 FOX HILL SUBDIVISION PREPARED FOR: MR. PAUL MEYER5 PO BOX 670485 CHUGTAK, AK, 99567 • ti ,. erg s >� NOT TO SCALE DRAWN 8Y CAL CONSTRUCTING ENGINEERS 346-2000 EF 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 3--18-93 DRAWING N 93-S2-03--1 • ae Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: FAVI MectOys LEGAL DESCRIPTION: I_ 1 `ti 7 - DEPTH (FEET) OVca_Y,NC., 2 3 \ / 1 Stl� gv.Ve�wl 4 / Cnbhtrs M 7 a � twc pros L� 9- 10 - S AtvD 11 12 13 14 15 16 17 18 19 20 DATEPERFC Township, Range, Section: S w �+ 54 -TI SN p,,jJ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? _ /o S lV IF YES, AT WHAT L DEPTH? O 4 P E u Depth to Water Alter Monitoring? t -A Dale: 3a 10-93 Reading Date Gross Time Net Time Depth to Net USC 5A"Dy TEST RUN BETWEEN Water Drop - 3- 5-ETWI'n X -r �� b uiif F=oNc '5"0QT>T1oY') �i�P/glfP I 1��r 1d�e• �lyl Z l" '3 4 Rte, Y (7 Z, PERFORMED BY: r "SCA yt`�)�a CER] IFY THAT THIS TEST pWAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: J7) j- 1`3- 72-008 (Rev. 4/85) v PERCOLATION RATE �" _ (minutes/inch) PERC HOLE DIAMETER n USC 5A"Dy TEST RUN BETWEEN S � FT AND 9 S _FT COMMENTS SOJL 5-ETWI'n X -r �� b uiif F=oNc '5"0QT>T1oY') �i�P/glfP PERFORMED BY: r "SCA yt`�)�a CER] IFY THAT THIS TEST pWAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: J7) j- 1`3- 72-008 (Rev. 4/85) v JRORRa.PROPERTIES TEL No.907-688-1310 MaY 4,93 9:50 P.01 - r.••+-«,..ay.,... aw.-.: •, '..iv`^`-•'M1�r�w+^-�FiG -ane..,...,....... _ _...s_. by w7 DOC Co. dba SULLIVAN WATER WELLS P.O. BDX670279, CHUGIAK, ALASKA 99567 r TELEPHONE 68sw'9ti ,VNER OF LAND31 C• 1 F+,ti�/1tG r l,t} ti lf'��..:-�.______. _.�,...._ DEPTH tJlWP:LL d :)DRESS fil"•iTIL I..itS':l.Cli 6i'.4ILRrr. !.,.... :,CAL DESCRI!''r ONA0i_--( . W. t3RrIV' I'st3ttiM ! ( t'I'[? • Started [-tided .,_3 101111 NUMBER kl N'D0!'CA.MN(-; ND OF FORMAIJON: r gym_.. .._.. FA.rom._•_..,.—Ft. to­ Ft.,— Otn..`�`.�_:_ I't. IrF �� __ F'!.. �.i''.1_.5._.J°d..c. i �_ � �s•y/''ywl�' Fruth.. I`[. Pu_.__—..,.$'3.._..----_._...--__ _— ... w -Ft, to..n. F[..— }d'_- -: 4 *.£: e i:.4r a Sts ....... .. ?: ,'` ..'FS..-, .-*"<^J rC .tir ,•�t ,1�='t` i':irm r 6�rurts,.,..w_._.. €'t. rxr_—._. Fi..,,_.___- tJ477, —.Ft. l(5, �.� �__,Ft�� V�",'•ai l? k,. RJ,.;:.,. /- wtl_ Pas_ ..___. Ft utn_,.._. ...-Ft. to-. um- .__—_,Ft-to--_._ .Ft..._._ i, :rm. .._._.._Ft. izs. -. Ft.__ .._..._--._._.. I•mm—­Fi From—'.... ---•-� --�— ➢°roto...._—._.Fi,{tr. .___Ff,_ .__�—_. .._—�_. nts ..._.—_F t. tn,. _._—.F•'t... ..__.—.._._..... - from—__Fa.—_---- m...... Ft. tv—�.. Ft. pus. Frocn._._._._—.Ft. to- ------------- _—_._... —gi (1. . INFORMATION: JUL 7.19:93 tdltt��H�.rnan Seruiaes Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Ru ERTIFICATE Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. n 5 I- M B -to COSA# QQ Li4 D 1. GENERAL INFORMATION Expiration Date: ZzIt9 08 Complete legal description FOX HILL SUDMSION, LOT 1. BLOCK 2 Location (site address) 21936 WOODCLIFF DRIVE • CHIGIAK. AK 99567 Current Property owner(s) SALLY GOBLE Day phone 242-1564 Mailing address PO BOX 671214 * CHUGIAK. AK 99567 Lending agency Day phone Mailing address Real Estate Agent LANCE BAILEY w/PRUDENTIAL JACK WHITE Day phone 689-6498 Mailing address 3801 CENTERPOINT DR. 11200 * ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, base on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that tho -s water supply and/or wastewater disposal system is (are)fe, functional and adequate for the num �f bgdt oms and type of structure indicated herein. I further vergy [hat based on the info r rff�O Wired from the Municipality of Anchorage files and from my investrjatr and inspection, the o is and/or wastewater disposal system !s(aro) in compliance with all app 'Cable Municipal arnica codes, ordinances, and regulations in effect at the time of installation. w Name of Firm GARNESS ENGINEERING GROUP, Ltd. I Phone 337-6179 Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date It 113 /07 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system These conditions are outside the control of the evaluator of the system. Satisfactory tes results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benofrt of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will if confor any legal right whatsoever. 5. DSD SIGNATURE Approved for ':�)_ bedrooms. CE -7955 ...........• ��i Disapproved. Conditional approval for bedrooms, with the filowing stipulations:,:` Y OF 36'I A4 ON-SITE - PROGRAM ., Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other By; Original Certificate Date: .!9 10 7 (Rev. 71N5) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragew Street P.O. Box 1966W Anchorage, AK 99519650 www.muni.org/onsite (907) 343 7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: FOX HILL S/0, LOT 1 BLOCK 2 Parcel ID: 051-073-07 A. WELL DATA Well type PRWE If A, B, or C provide PWSID# N/A Date completed 4/1993 Sanitary seal (Y/N) YES Total depth 100 ft. Cased to 40+ ft. FROM WELL LOG Data of test 4/1993 Static water level 71 ft, Well production 25 g,p,m, WATER SAMPLE RESULTS: Coliform _0 colonies/100 ml. Arsenic: 0.547 ug,/L, B. SEPTICIHOLDING TANK DATA Well Log (Y/N) YES WIMS property protected (Y/N) YES Casing height (above ground) 12+ In. AT INSPECTION 10/28/2007 70 ft, 9.5 g.p.m. Nitrate 1.94 mg./L. Other bacteria _0 colonies/100 ml. Date of sample: 10/29/2007 Collected by: GEG Ltd. Tank Typo/Material SEPTIC/ STEEL Tank size 1000 gal, Number of Compartments 2 Foundation deanout (Y/N) YES Depression over tank (YIN) NO Date Installed 11/7-12/2007 Cleanouts (Y/N) YES Date of pumping NEW Pumper C. ABSORPTION FIELD DATA.. w i 4/23-24 1993/ BELOW FINAL QRADE Date installed 11/7-1 /2007 Soil rating(6.p.d. r ftlbdrm) 1-2/0-8 High water alarm (Y/N) N/A System type WIDE TRENCH Length 46'5 7 ft. Width 394/ 5/5 ft. Gravel below pipe 3/4.02 ft. Total depth •*9.94 ft. EB. absorption area 576 ft' Monitoring tube YES Depression over field NO Data of adequacy test NEW Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test = In. Water added =gal. New depth =1n. Elapsed Tune: = min. Final fluid depth = in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN . If yes, give date _ D. LIFT STATION Date installed Size in gallons Manhote/Acoess "Pump on" level at _In. "Pump2T I � High water alarm level at in. natum Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent kits 100'+ Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property Ilne 5'+ Absorption Heid 5'+ water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway. parking/vehicie storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION .• 1 certify that I have determined through field inspections and. +' ; . fes.....;.*, review of Municipal records that the above systems are in conformance with MOA COSA guidelines In ailed on Mit ..... ................ date. Gar ss: Engineer's Printed Name ,JEFFREY A GARNFSS Pogj CE Date COSA Fee �%&" US i,t Waiver Fee E Date of Payment j AMW Receipt Number (P v. 1trot) Date of Payment Receipt Number Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING/ '/,/-y Parcell.D. 051-073-07 HAA# I in /V / 1. GENERAL INFORMATION Expiration Date: Complete legal legal description FOX HILL SUBDIVISION; LOT 1, BLOCK 2 Location (site address or directions) 21936 WOODCLIFF DRIVE * CHUGIAK, AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SCOTT GLOVER Day phone 688-5398 21936 WOODCLIFF DRIVE * CHUGIAK, AK 99567 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served,by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. PPA1) /Vote: Alaska Water and Wastewater Consultants, inc. shall be paid $ at, orprior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date 7 � C 2 bedrooms, with the flowing stipulations: Manitenance Agreements Supplemental Engineer's Reort Other WATER AND PROGRAM .' By: Original Certificate Date:�'� (Rev. 12101) Municipality of Anchorage A Development Services Department W, Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: FOX HILL S/D; LOT 1, BLOCK 2 Parcel ID: 051-073-07 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 4/1993 Sanitary seal (Y/N) YES Total depth 100 ft. Cased to 40+ ft. FROM WELL LOG Date of test 4/1993 Static water level 71 ft. Well production 25 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.51 mg./L. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 6/3/2002 74 WIT-] Other bacteria 0 colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 6/4/2002 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 4/23-24/1993 Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 6/15/2002 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 4/23-24/1993 Soil rating OE> ft2/bdrm) 1_2 System type WIDE TRENCH Length 46 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 11 ft. Eff. absorption area 394 ft' Monitoring tube YES Depression over field NO Date of adequacy test 6/17/2002 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption Feld before test 11 in. Water added 9 14 gal. New depth 36 in. Elapsed Time: 605 min. Final fluid depth 27 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at _in. Cycles E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10,+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that t have determined through field inspections andQ Y* review of Municipal records that the above systems are in """' ' ' "" • "' ....... .. • • conformance with MOA HAA guidelines in effect on this date. Engineer's Print d N me JEFFREY A. DARNESS vQ��9.• C 7953 1 nnt o Date % f 9 jZ �u4O�nProfessiol, HAA Fee $ 3175. Date of Payment 'A/a, 1da— Receipt Number. ®""Z11 C,5 G1, (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # n6 1 — IQ1)1- CD HAA # � ('_-)"1 r�n �,InSc 1. GENERAL INFORMATION Complete legal description L 19Z F& -g 4,,1) S�lD Location (site address or directions) Property owner An An nf� C.o-n4v�-41-1/Yaol Mhers Day phone 6881�3/p Mailing address eo$o?' 6 -4o4 -9s A\<, 995��- Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA"wi I! be h for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well )< Community well Public water NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 7M25 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as.of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 9Cot Address Engineer's signature 6.- DHHS SIGNATURE � Approved for Disapproved. 'j Sbedrooms. Conditional approval for Additional Comments 346- woo/ 654- 96 !l-8 Date 1�0•30.915 — bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. r Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L 1 Y3 2 4 11 S A> Parcel LD A. WELL DATA Well type �l?1VY�T6 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 4/93 Driller 5up-L1VA2J wATe'k Total depth IDD Casedto IOU Casing height 3ovE G2f�l Sanitary seal (Y/N) `f Wires properly protected (Y/N) y Date of test Static water level Well flow Pump level FROM WELL LOG 4/93 711 13.x. ZS g.p.m. 95, SEPARATION DISTANCES FROM WELL TO: r(at Septic/holding tank on lot Absorption field on lot — Public sewer main Sewer service line - 1 46 -4 Z-00' S AT INSPECTION ; On adjacent lots d- loo' ; On adjacent lots I `E"� Public sewer manhole/cleanout tZoo Petroleum tank +) bd WATER SAMPLE RESULTS: Coliform Nitrate i` 6� Other bacteria Date of sample: 6" Z4-93 Collected by: t�L' B. SEPTIC/HOLDING TANK DATA Date installed VV0 7-30 993 Tank size rvoo q�l � Y Cleanouts (Y/N) Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping Compartments Z V A Alarm tested (Y/N; Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on IOL I (�, 8 On adjacent lots + I� i s To property lino 4G.Absorption field 4 Surface water/drainage +1� 72-026 (Rev 7/91) Front Depression (Y/N) N Foundation Water main/service line -r loo' CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Manufacturer Manhole/Access ) "Pump on" level at "Pump off' level at s. Meets MOA electrical codes (Y/N) SEPARATION DISTANCE_,,,FR6M LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water Date installed AeyI 1 1993 Soil rating l' Z� 5Pd ISS System type -DEEP u,tvL enol{ Length 4�- Width S ' Gravel thickness 3 ' Total depth III Total absorption area '941 Cleanouts present (Y/N) Depression over field (Y/N) N Results (pass/fail) Date of adequacy test N0711) 51y5t m for Peroxide treatment (past 12 months) (Y/N) 0 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 11-6 On adjacent lots 14-31 Property line 34' To building foundation 5D To existing or abandoned system on lot On adjacent lots Surface water am +)06' Cutbank "f 100 Water main/service line +--A 00 t I0p Curtain drain 4-A C& E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Signature Co7.s'}Y c-�ra.q 1r�eS�✓S Engineer's Name 2; oO\ C�^Olri f}K i � ssis Date tO' 30 HAA Fee $ % Date of Payment Receipt Number 72-026 Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CE' r v}esya 4� bedrooms of this inspection. 07/03/02 WED 12:26 FAX 1 907 696 3297 MAIL BOXES ETC 5!6" Asher found each corner N 69 - `A'21 E —559-08 o N rarrw � 2 N84- 7-5oW (NR) ,"S4419 herebyy .... Gm, Fly that a survey of lot 7 Bloch E rot Nill aubdlvision vas aeae ril 30, 1991 erd that the iaprovemmts situated thereon are within the PrMA nes and do not overlap or encroach on the property Lying adjeeent thereto, that proveaents on property Lying ad scent thereto enorweh on the promisee In quest d that there ere no roadwaYs, trens01ieslon tinea or other visible ceeeaants on a operty except as sham hereon. tt is the responsibility of the owner to datermine istsnoe of any tesetknts, cov'4 to or restrictions which do not appear an ,Carded aubdlvlelon Plat. Under no circumstance■ should any data Mrson oa Used nstruotion or for astebtishino boundary or 460100 lines. Ked in MchoraQe, AK, April 30, 1993 CONSTRUCTING 1SUGI11BZRS AS -BUILT 6URVSY 9601 Buddy Warner Dr Anchorage, UP 99516 366-3000 694-9098 low ,oL1 Cif 003 Cocuaar oocuac+ir pfPRPAIV pg1Ve L9461it. R= 2o.ao RAL